Maxillomandibular advancement surgery and weight counseling is one treatment alternative for morbidly obese patients with obstructive sleep apnea when other less invasive treatment options are unsuccessful.

More studies of MMA as treatment for OSA in the morbidly obese are needed to confirm MMA efficacy. However, the limited data available indicates MMA as a successful treatment alternative to CPAP in morbidly obese patients with obstructive sleep apnea. Post-MMA data demonstrated a 89.4% reduction in AHI, a 20.5-point improvement in lowest oxygen saturation, and decreased sleepiness. The MMA surgical success rates were comparable between the morbidly obese (85.3%) and normal BMI patients (86%) but a lower cure rate was observed in the morbidly obese patients (43.2% vs. 26.5%).

The post-surgical apnea-hypopnea index (AHI) was 6, and the lowest oxyhemoglobin saturation level increased to 86% (compared to pre-surgical AHI of 139, and lowest oxyhemoglobin saturation level of 73%). These results suggest that MMA should be considered for morbidly obese, CPAP-intolerant, patients with severe OSA.

The current search did not locate any information directly comparing CPAP to MMA in morbidly obese individuals with OSA; there appears to be a lack of direct evidence on the subject. However, the current available research suggests the validity of MMA surgery as a viable alternative treatment in cases where CPAP is ineffective.
Validity: Both articles have low validity (low evidence hierarchy). The Comacho article summarized data based on information collected from inadequate sample sizes (34 total) and the Doff article is a case study of a single patient. Multiple case reports and or case series will help to verify these conclusions and validate clinical efficacy of MMA in obese patients and also produce more clear selection criteria to assist practitioners in patient selection.

Applicability

Potential patient harm can result from non-comprehensive patient screening. MMA should not be a practitioner’s first automatic treatment option for morbidly obese patients with OSA. Patients should be evaluated with other less invasive treatment alternatives such as CPAP, or mandibular repositioning devices before consideration of MMA surgery. Risk benefit models should be utilized in decision making because, for those cases where MMA in indicated, the procedure appears efficacious.

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